Analysis of a Hand Hygiene Program to Reduce Healthcare Infections

This report examines a hand hygiene program, specifically the "Five Moments of Hand Hygiene" initiative, implemented in Australian healthcare settings to combat healthcare-associated infections (HAIs). The program, driven by the Australian Commission on Safety and Quality in Healthcare, aims to improve hand hygiene compliance among healthcare workers, which is crucial for reducing antibiotic resistance and patient safety. The report outlines the program's key components, including educating patients and staff on the five moments: before touching a patient, before a procedure, after exposure to body fluids, after touching a patient, and after touching the patient's surroundings. It details the evaluation strategy, which involved collecting data on compliance rates and assessing the impact on Staphylococcus aureus bloodstream associated infection (SABSI) rates. The findings indicate an overall improvement in hand hygiene practices, particularly among nurses, and a reduction in SABSI rates. The report concludes by highlighting the need to address barriers to compliance and suggests targeted communication strategies to reinforce hand hygiene practices, especially focusing on the most critical moment (moment 1), and promoting the use of alcohol-based hand rub to further reduce HAIs. The data was collected to assess compliance and reduction in health care associated infection in hospital setting.

Five moments of hand hygiene program:
An initiative to reduce health care
associated infection
Background and evidence
The Australian commission on health and safety in health care engaged in
the hand hygiene Australia (HHA) to execute the National hand hygiene
initiative (NHHI). Hospital acquired infections in any clinical settings are
mainly caused due to the compromised hand hygiene. Poor hand hygiene
practices among health care workers is associated to health care
associated infections (HAI). Improvement in the hygiene among the health
care workers is the key to reduce the antibiotic resistance organisms
within the health care settings (2). Hence the five moments of health and
hygiene has been prioritized by the ACSQHC. The health care associated
programs poses a serious threat to the admitted people in the hospital and
causes health café burden to health care.
As per the government records around 200,000 HAI cases are found in
Australian settings each year and it is possible to reduce the infections by
compliance with the hand and hygiene. According to the researches,
compliance to hand and hygiene is about the organizational culture,
human behavior and leadership that requires a multifaceted approach for
achieving the hand and hygiene compliance. The compliance program
included several education programs, administrative rules, feedback from
the clients and positive reinforcement, leadership and motivation (1).
The key elements of the program were as follows:
1. To educate patient about five moments of hand hygiene which are as
follows:
Moment 1: Before touching the patient
Moment 2. Before the procedure
Before the handling of surgical instruments for the patient, or while moving
the instruments from a contaminated body site to a clean body site at the
time of the patient care.
Moment 3: After a surgery or when the body fluid is exposed to risks.
After the removal of the gloves, after the contact with the excretions and
the body fluids, non intact skin and the wound dressings.
Moment 4: After touching the patient
Moment 5: After touching the surrounding of the patient.
2. The program targeted five indications for hand hygiene associated with
interaction with staff, patient and environment.
3. The five moments of hand hygiene aimed to protect patient against
harmful germs carried on by health worker’s hand to patient and to
prevent germs from entering the body.
4.The program focused on improving the health care environment and
make the environment safe for patient (5)
The five moments of hand hygiene
References:
1. Hand Hygiene Australia. 2017. Five moments for Hand Hygiene
http://www.hha.org.au/AboutHandHygiene.aspx
2. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B,
Magiorakos AP, Pittet D. Hospital organisation, management, and structure for
prevention of health-care-associated infection: a systematic review and expert
consensus. The Lancet Infectious Diseases. 2015 Feb 1;15(2):212-24.
3. Shobowale EO, Adegunle B, Onyedibe K. An assessment of hand hygiene
practices of healthcare workers of a semi-urban teaching hospital using the five
moments of hand hygiene. Nigerian medical journal: journal of the Nigeria Medical
Association. 2016 May;57(3):150.
4. Salmon, S., Pittet, D., Sax, H. and McLaws, M.L., 2015. The ‘My five moments for
hand hygiene’concept for the overcrowded setting in resource-limited healthcare
systems. Journal of Hospital Infection, 91(2), pp.95-99.
5. Azim S, McLaws ML. Doctor, do you have a moment? National Hand Hygiene
Initiative compliance in Australian hospitals. The Medical Journal of Australia. 2014
May 19;200(9):534-7.
6. Shobowale EO, Adegunle B, Onyedibe K. An assessment of hand hygiene
practices of healthcare workers of a semi-urban teaching hospital using the five
moments of hand hygiene. Nigerian medical journal: journal of the Nigeria Medical
Association. 2016 May;57(3):150.
Aim and goal of the program:
• To educate the patient as well as the health care staffs regarding the five moments of
hand hygiene.
• To reduce risk of infectious disease in health care setting
• To assist hand hygiene educators and health care workers in minimizing ambiguity
surrounding shared patient zones.
The evaluation strategy used:
After the implementation of the program in hospital setting, data for many
public hospitals was collected regarding hand hygiene opportunities in
the first quarter of the year. The data was collected regarding each of the
five moments (to assess compliance) and number of moments completed
by staffs. Data from MyHospital website was also collected which
publishes results on hand hygiene rates and Staphylococcus aureus
bloodstream associated infection (SABSI) (5).
The assessment of hand hygiene practices among staffs after the
implementation of the program was judged by:
• Compliance to five moments of hand hygiene
• By observation of hand hygiene practices implemented by health care
staff in clinical setting
• By assessment of reduction in health care associated infection in
hospital setting
• By increase in positive patient outcome
• Another measure that was taken to evaluate the effect of the program
was to measure patient safety by the reduction in rate of
Staphylococcus aureus bloodstream associated infection (SABSI) (3)
Conclusion
After the implementation of the program, it was found that compliance rate was higher
for before touching a patient. However, the compliance rate of hand hygiene practice
was higher for nurses compared to other medical staffs. This was independent of the
hospital size (5).
As the outcome of the program showed overall improvement in hand hygiene practices
and reduction in SABSI rate, there is a need to work on barriers and poor compliance
rate in medical staffs. As moment 1 is most crucial than other five moments, there is a
need to develop campaign message that focus on one moment at a time. The message
should be given to one health care worker at the start and this may start with medical
staffs first. Proper communication with worker is also necessary to identify any barrier
that they face in implementing the hand hygiene moments. This may help to modify
resource or change practice environment so that staffs are better placed to effectively
cover all moments of hand hygiene (4). Health care associated infection is an important
cause of comorbidity and high health care cost. To reduce the burden to the system,
appropriate hand washing practices and use of efficient alcohol based hand rub is most
effective. Promoting the use of alcohol-based hand rub in Australian hospital is crucial
to reduce the rate of health care associated infection
Figure 1: Five moments of hand hygiene. Source: (1)
FIgure 2; Techniques to implement hand hygiene. Source: (4)